Staying safe: Making fall prevention a top priority

Our graying society must reckon now with a surprising, debilitating, and even lethal harm: preventable falls.

Circus clowns and slapstick artists make falls look like a joke. But for real people, they’re not.  Falls are landing record numbers of patients, especially older adults, in emergency departments – in pain and with serious and costly injuries.

The good news is that we can all take simple steps to tune into hazards and reduce the odds of a serious mishap.

The statistics are alarming on falls and the damage they cause, especially for older adults.

Researchers in 2018 found that 1 in 3 Americans 65 and older reported falling within the last year, with 1 in 10 suffering a fall-related injury. Emergency departments report 3 million older patients had serious enough falls to require medical care in their facilities.
Women say they tumble more than men do, but men die from falling more than women do.

In 2021, almost 40,000 older Americans died due to falls and their complications. This is a higher number than the 2022 U.S. record high for gun-related suicides and nearing the terrible toll of traffic-related deaths in this country.

As the nation grays by the day — with demographers estimating that each day 10,000 baby boomers cross the age 65 threshold — the carnage attributable to falls is soaring, too: The death rate doubled between 1999 and 2020, studies show.

For seniors, falls that don’t result in death still can have grievous consequences. Spills are blamed for 95% of hip fractures. These are serious injuries that can hospitalize older adults and, with immobility, lead to a downward health spiral. Falls are also the most common cause of traumatic brain injuries for older patients.

They’re called sentinel events by the Joint Commission, the independent organization that accredits U.S. hospitals.

That’s a euphemism for incidents in institutions that cause “death, permanent harm or severe temporary harm.”

Falls are the No. 1 voluntarily reported sentinel events occurring each year in hospitals. They made up half the number of serious patient harms recorded by the commission, which expressed concern in 2023 about their still-increasing numbers and blamed the coronavirus pandemic for worsening efforts to improve patient safety, especially with falls.

Doctors, nurses, and others who work in hospitals have campaigned for a while now to decrease this preventable harm for the vulnerable in their care. As the commission noted in a longstanding alert to its member institutions:

“Elderly and frail patients with fall risk factors are not the only ones who are vulnerable to falling in health care facilities. Any patient of any age or physical ability can be at risk for a fall due to physiological changes due to a medical condition, medications, surgery, procedures, or diagnostic testing that can leave them weakened or confused…

“Every year in the United States, hundreds of thousands of patients fall in hospitals, with 30%-50% resulting in injury. Injured patients require additional treatment and sometimes prolonged hospital stays. In one study, a fall with injury added 6.3 days to the hospital stay. The average cost for a fall with injury is about $14,000 …”

Nursing homes, skilled nursing facilities, and other care-giving centers share with hospitals the problem of patient falls — a problem afflicting 700,000 to 1 million of them annually, according to information from a federal quality and safety health care agency.

Experts know that the ailing, injured, and old take their spills while walking around facilities, getting out of bed, struggling with wheelchairs, or using the bathroom.

It’s understandable: Patients find themselves strapped into an array of electronic monitors and cords and intravenous lines while wearing unfamiliar garb and footwear.

In a perfect world, nurses or aides would be instantly assisting patients as they navigate their space while dealing with their own infirmities and the confusion of modern health care facilities. In reality, dazed patients try to get up alone and then tumble to the floor. They feel the discomfort and urgency of needing a bathroom and can’t wait after signaling for help.

They also may be trying to walk in a hall where liquids have spilled, or unforeseen obstacles (carts, floor coverings, other patients) may trip them up. The lighting may be dimmed (at night) or just poor.

To safeguard patients from falls, hospital staff have policies and procedures they’re supposed to comply with.

Clearly, more needs to be done. But there’s an increasingly common shift-and-shaft approach to dealing with institutional falls, particularly those in care facilities for the elderly. First responders are expressing increasing frustration and alarm that nursing homes, skilled nursing facilities, and assisted-living centers are calling 911 to get fire fighters and paramedics for “lift assists” — help in getting residents up after a fall.

Embarrassed residents and staffers say that facilities lack the equipment and muscle to assist seniors who have taken a fall. Aides worry about injuring their own backs. Facility owners and operators express concern about legal liabilities. Burdening first responders is becoming an unhappy and too-common practice, the Washington Post found, reporting this:

“Lift assists are now the seventh most common type of 911 call, with an average of 1,800 lift-assist calls every day nationwide, according to an analysis of the National Fire Incident Reporting System, which collects emergency calls from more than 23,000 fire departments. The data does not include calls to about 13,700 EMS agencies, although there is significant overlap in calls between the two databases.

“The calls come often from elderly people living both at home and at facilities. While both situations strain resources, fire officials said senior-care homes should be equipped to handle these calls.”

Some agencies have begun assessing fees for lift assists, a response that upsets the owners and operators of care facilities. They say that residents should get governmental help whether at home or in an institution because they and their loved ones fund fire and government paramedic services with taxes.

The friction is increasing between local governments and care facilities. Besides the fees, shouldn’t fire and government paramedic agencies be keeping track of excessive lift assist calls from certain spots, reporting them, in turn, to state and federal regulators overseeing such facilities?

Hospital patients and nursing home residents — already vulnerable and requiring significant care for injuries and illnesses — should not be harmed by falls while under treatment. That sounds like common sense and an inarguable fundamental.

So why do as many as 1 million hospital patients and half of nursing home residents take problematic falls in institutions — and why isn’t more being done about this?

Dig into the published studies and researchers concede there aren’t easy solutions, as a blue-chip federal advisory group concluded in a recent review of various approaches.

Federal regulators have slapped hospitals with a penalty that requires institutions, not coverage programs like Medicare or Medicaid, to bear the cost of treating patients who fall while under care.

Doctors and others have developed tools to screen which patients might be most fall prone based on their age, medical history, conditions, medications, and the like. This information is supposed to be paired with an array of other measures to safeguard those at risk.

Hospitals have tried changing flooring materials (carpet vs. tile), hooking patients up to alarms that sound when they get up from their beds, issuing purported low-slip socks, and hiring modestly trained aides to sit in rooms to monitor slip-prone patients.

Studies haven’t shown that any of these approaches are successful on their own, and researchers say that institutions may need to apply multiples of them in a concerted campaign.

Considering the terrible toll of falls, why not? The Joint Commission, the national hospital group, needs to step up even more its work to determine more effective solutions to this problem.

Federal regulators have sought to slash other perils for patients, including infections acquired during medical treatment. They have done so by publishing data so the public can see which institutions have problems in this area and others, such as worrisome readmission rates. So why not disclose, for example on the Medicare ratings site, which hospitals and nursing homes do poorly in safeguarding those in their care from crashing to the floor with calamitous results? (A telling challenge to this option: Regulators concede that self-reported fall data from institutions can be difficult to evaluate for accuracy and for comparison purposes.)

It may be that, as hospitals throw up shiny new building after building, medical architecture and space design requires reconsideration. More fancy places have gone to single-patient rooms and focused on high-tech demands, such as where a proliferation of electronic devices can be hooked up for patient care. How about figuring out how to minimize the distance between patient beds and bathrooms — redesigning those facilities so they continue to be hygienic but with greater thought in making them safe and more navigable for the ill and injured?

How about hospitals (and nursing homes) forgo a few corporate vice presidents and other business-side swells to ensure that patients and their loved ones see more frontline caregivers? Nurses and aides shoulder a big burden in many institutional fall-prevention programs. They should be making their rounds more proactive and often, experts say.

That is a challenge, though, when the nurse and aide ranks are thin and the MBAs running hospitals and nursing homes seek maximum profits by slashing staffing (just look at how hard the nursing home industry is battling efforts to impose national minimal staffing standards.) Simultaneously, as technology soars in medical care, nurses and frontline staff find themselves anchored in distant centralized stations to deal with the walls of electronic sensors and monitors to which patients are now hooked up. Doctors, nurses, patients, and loved ones all complain, too, about the cacophony the devices can launch — often false alarms triggered by who knows what but demanding staff resets.

Meantime, here’s one tip for families with a loved one in the hospital or a nursing home: Get a “sitter” to sit with the patient overnight. That way when nature calls and the patient needs to go to the bathroom, they won’t have to wait for overworked, understaffed aides to answer the call button.  Expensive, yes, unless a saintly family member can do it for free. But either way, having a sitter is a lot cheaper than dealing with the aftermath of a bad fall.

It costs on average more than $50,000 to treat a broken hip in an older adult, according to 2014 federal data. The cost to treat a broken arm, without insurance and if surgery is required, could zoom to $16,000-plus, while a broken leg would run up a tab in excess of $35,000 for the uninsured, a health coverage enterprise estimates.

Savvy consumers take the sensible way to avert budget-busting costs like these by taking a little time and a few resources to prevent fall hazards in their homes and workplaces.

The federal government and others offer free guides and other resources for fall prevention, accessible here from the Centers for Disease Control and Prevention and here from the National Institute on Aging and here from the National Institutes of Health. Read the advice, including from groups like the AARP, and some key approaches emerge.

To start, older adults must be realistic about their skills and capacities and how they may diminish with age. Sure, climbing ladders and trees once was a snap. Getting on rooftops or stretching from a chair to high cabinets was a youthful breeze. But when we’re older, it may be riskier and far less financially sensible to tackle many household chores. Listen to loved ones, friends, and doctors for their independent assessments of what keeps you safe.

With more older adults taking increasing amounts of over-the-counter and prescription medications and enjoying their leisure to excess with alcohol, marijuana and more, it’s too easy for too many to be tipsy — and to take a bad fall. Talk to your doctor and pharmacist about all the prescription meds, supplements, and intoxicants you consume so they can help you understand your risks, especially for falls.

How good is your eyesight and balance these days? Consider taking up a modest exercise program to better your strength and stability as you age. It takes more than cardio to keep up your well-being, with many older adults finding benefits in practices of tai-chi and yoga. If you need glasses, do you try to march around — or stumble — without them? Are your vision prescriptions current, or are you squinting through specs outdated for you?

Honestly: Do you struggle a little more to navigate in dim light or the dark? Technology’s advances have made snappy night lights smarter and more affordable to buy and use. They can switch on when the sun goes down or only when they detect motion. They go up and install easily with battery or solar power, meaning they can light paths outside your home or inside (especially the way from bedroom to bathroom).

Those boots, shoes, sandals, and slippers may be favorites now that they have gotten comfortable and worn. Do they present their own hazards because they are holey, floppy, or thread-bare?

As you navigate familiar spaces, are perils under foot or in the way that you can remedy – by moving bulky and awkward furniture, eliminating or skid-proofing rugs, carpets, and mats, and replacing smooth, slick surfaces?

Bathrooms pose their own risks that can be reduced with safety mats for the tub, as well as grab-bars and handrails. Don’t fill the space underfoot in the tub or shower with a beauty shop’s supply of slippery soaps, shampoos, conditioners, and other products. Consider getting a special stool or seat for the shower.

That spacious, high-sided tub gets less appealing for soaking when getting in it becomes a gymnastic event. For homeowners contemplating major remodels, bling may not be the thing, as opposed to sensible showers without thresholds and bathrooms that accommodate wheelchairs and walkers.

Wherever water or other wet stuff hits the floor, for safety’s sake, it’s good for everyone in the household if messes get mopped up, pronto.